Birth-control fight shows folly of federal mandates

The Catholic bishops may be wrong about birth control, but they're right about the rest of this month's fight.

They're
right to be dissatisfied with President Barack Obama's "accommodation"
on the federal contraception mandate. They're right to make a stink. And
they're right to point out some fundamental problems with federal
mandates on health care, whether for high-ranking religious figures or
regular Joes.

Under rules established by the Obama
administration, all insurance plans must offer birth control as a form
of preventive care. The feds decided to exempt churches from the
requirement but not Catholic hospitals and other religious-affiliated
groups. As you may have heard, this narrow exemption went over poorly
with the Catholic bishops. So did the hasty workaround that shifted the
birth-control burden to insurers rather than religious employers -- a
switch that was more semantic than substantive.

Now we've
managed to spend the month of February talking about birth control
rather than jobs. Much of the conversation is unpalatable, between
Catholic leaders condemning contraception, Republicans bloviating about
religious liberty, Democrats clamoring about sexism and political donor
Foster Friess telling the ladies how to prevent pregnancies with
aspirin. It's tempting to tune the whole thing out. However, at the core
are serious questions about the scope of federal power, namely:

Should Congress and the president be able to tell you exactly what products to buy?

Should they be able to punish you for failing to buy those products?

When you protest and they grant an "accommodation," is that enough?

These
questions have less to do with birth control (which is indeed a basic
part of good health care) and more to do with citizens' ability to push
back on the federal government. This ability is central to American
life, whether the leader defining your best interest is President Obama
or President Santorum.

Americans support most parts of the
health care reform pushed by Obama and passed by Congress in 2010,
according to national tracking polls by the Kaiser Family Foundation.
They love the tax credits for small businesses. They like closing the
Medicare "doughnut hole." They like the new rules preventing insurance
companies from discriminating against people who actually need
insurance.

However, they've never liked the mandate requiring
individuals to buy insurance. Fully two-thirds of Americans want to
repeal that mandate, a level of opposition that has stayed high since
the law's passage. This high-profile flap with Catholic leaders over
mandatory contraceptive coverage is likely to boost public discomfort
with the individual mandate by sharpening concerns about government
overreach. Though the types of mandates are different, similar
principles apply.

Looking ahead, I see two likely events. First,
the Obama administration may try to quell the unrest by creating a
broader accommodation for religious-affiliated organizations. Second,
the Supreme Court may correctly strike down the individual mandate as
unconstitutional. (Such a ruling might complicate health care reform but
wouldn't necessarily doom it: In fact, a study released last week by
the nonprofit RAND Corporation found that the cost of health insurance
on the individual market would rise by just 2.4 percent if the mandate
went away.)

Meanwhile, many states will press ahead with health
care reforms that don't depend on federal mandates. Here in Oregon, that
includes setting up "CCOs," coordinated care organizations designed to
reduce expensive hospital stays through better disease management. It
also includes fast-tracking a new health insurance exchange, a regulated
online marketplace where people can comparison-shop for coverage.

These
are promising ideas. They remind me of Obama's position as a
presidential candidate, when he opposed mandatory insurance and said the
proper federal role was to make health care more affordable, not force
people to buy policies.

That was then. Now Obama is stuck
playing defense, trying to persuade people to see forced coverage in a
more flattering light. He'd be smart to change the conversation, because
the mandate debate is one he can't and shouldn't win.